Analgesic efficacy and safety of erector spinae versus serratus anterior plane block in thoracic surgery: a systematic review and meta-analysis of randomized controlled trials

Qurat Ul Ain Muhammad; Muhammad Ahmad Sohail; Noor Mahal Azam; Hafiza Hifza Bashir; Hira Islam; Rana Ijaz; Sakina Aquil; Tehreem Mansoor; Bishal Dhakal; Tehniat Fatima; Javeria Noor; Alina Sami Khan; Arham Iqbal; Mahima Khatri; Satesh Kumar

doi:10.1186/s44158-023-00138-y

Analgesic efficacy and safety of erector spinae versus serratus anterior plane block in thoracic surgery: a systematic review and meta-analysis of randomized controlled trials

J Anesth Analg Crit Care. 2024 Jan 12;4(1):3. doi: 10.1186/s44158-023-00138-y.

Authors

Affiliations

¹ Rawalpindi Medical University, Chamanzar Colony, Tipu Road, Rawalpindi, 46000, Pakistan. qurat6243@gmail.com.
² Shifa College of Medicine, Islamabad, Pakistan.
³ Rawalpindi Medical University, Chamanzar Colony, Tipu Road, Rawalpindi, 46000, Pakistan.
⁴ Liaquat National Hospital and Medical College, Karachi, Pakistan.
⁵ Karachi Medical and Dental College, Karachi, Pakistan.
⁶ Services Institute of Medical Sciences, Lahore, Pakistan.
⁷ Dow University of Health Sciences, Karachi, Pakistan.
⁸ Nepalese Army Institute of Medical Sciences, Kathmandu, Nepal.
⁹ King Edward Medical University, Lahore, Pakistan.
¹⁰ Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan.

Abstract

Background: Erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) are regional anesthesia techniques that have shown favorable results in pain management following thoracic surgeries; however, their relative superiority is unclear. This review (PROSPERO: CRD42023443018) aims to compare the analgesic efficacy of ESPB and SAPB in patients undergoing thoracic surgeries through the pooled analysis of co-primary outcomes: postoperative oral-morphine-equivalent (mg) consumption in 24 h and pain scores (static) at 24 h.

Methods: A literature search was conducted across PubMed, Cochrane Library, and Google Scholar to identify randomized controlled trials (RCTs) from inception to May 2023, comparing ESPB and SAPB in thoracic surgeries. Statistical pooling was done using Review Manager 5.4.1. Bias assessment employed the Cochrane Collaboration Risk-of-Bias 2.0 tool. The strength of evidence was assessed using the guidelines from the GRADE working group.

Results: Nine RCTs (485 patients) were included in the study. Postoperative pain scores (static) at 24 h (mean difference (MD) = - 0.31 [- 0.57, 0.05], p = 0.02) and postoperative oral-morphine-equivalent (mg) consumption in 24 h (MD = - 19.73 [- 25.65, - 13.80], p < 0.00001) were significantly lower in the ESBP group. However, the MDs did not exceed the set threshold for clinical importance. No significant differences were observed in the opioid-related adverse effects and block-related complications.

Conclusion: Our statistically significant results imply that ESPB has superior analgesic efficacy compared to SAPB; however, this difference is clinically unimportant. The safety profile of the two blocks is comparable; hence, current evidence cannot define the relative superiority of one block over the other. Our findings warrant further research with standardized methodologies and a longer duration of analgesic efficacy assessment to yield robust evidence for better clinical applications.

Keywords: Nerve Block (D009407); Post-operative Pain (D010149); Regional anesthesia; Thoracic Surgery; Thoracotomy (D013908); Video-Assisted (D020775).

Publication types

Review